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Multicenter Study
. 2020 Sep;20(5):e178-e182.
doi: 10.7861/clinmed.2020-0346. Epub 2020 Jul 21.

Von Willebrand factor (vWF): marker of endothelial damage and thrombotic risk in COVID-19?

Eleni E Ladikou  1 , Helena Sivaloganathan  1 , Kate M Milne  1 , William E Arter  2 , Roshan Ramasamy  3 , Ramy Saad  3 , Simon M Stoneham  1 , Barbara Philips  4 , Alice C Eziefula  1 , Timothy Chevassut  5
Affiliations
Multicenter Study

Von Willebrand factor (vWF): marker of endothelial damage and thrombotic risk in COVID-19?

Eleni E Ladikou et al. Clin Med (Lond). 2020 Sep.

Abstract

Background: COVID-19 infection is characterised, among other features, by a prothrombotic state with high rate of venous thromboembolism (VTE), D-dimer, and fibrinogen levels. Clinical observations have also highlighted that these patients have elevated von Willebrand factor (vWF) and factor VIIIc.

Methods: 24 consecutive COVID-19 positive patients were selected from the intensive care unit (ICU) or the high acuity ward of Brighton and Sussex University Hospitals NHS Trust.

Results: The rate of VTE was 25% and mortality rate was 16.7%. Fibrinogen and D-Dimers were elevated, 7.9 (1.6) g/L and 2.4 (2.02) ug/ml respectively. Factor VIIIc and von vWF antigen levels were both extremely elevated at 279 (148) u/dL and 350 (131) % respectively, which are comparable to levels seen in ICU patients with severe sepsis. vWF levels were significantly higher in patients that died (p=0.017) and showed a positive correlation with age. There was a statistically significant association between COVID-19 disease and non-O blood group (p=0.02); 80% (4/5) of COVID-19 patients with VTE were blood group A.

Conclusion: Very high levels of vWF and factor VIIIc are common in COVID-19 patients, comparable to levels in severely septic non-COVID ICU patients. This could contribute to the hypercoagulable state and increased VTE rate in COVID-19. Further studies are needed to evaluate the use of vWF for stratifying thrombotic risk in COVID-19 and to determine if elevated vWF is contributing to disease pathogenesis.

Keywords: COVID-19; blood group; factor VIIIc; venous thromboembolism; von Willebrand factor.

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Figures

Fig 1.
Fig 1.
Schematic representation of how SARS-CoV-2 entry damages the endothelium, which subsequently results in vWF release mediating platelet aggregation and adhesion.
Fig 2.
Fig 2.
Percentage (%) von Willebrand antigen in patients that have passed away or remained alive at the end of the study.
Fig 3.
Fig 3.
Scatter plot of vWF antigen (%) in relation to age in COVID-19 patients.
See this image and copyright information in PMC

Comment in

  • Von Willebrand factor.
    Bhogal P, Jensen M, Hart D, Makalanda L, Collins GB, Spooner O, Jaffer O. Bhogal P, et al. Clin Med (Lond). 2020 Nov;20(6):e279. doi: 10.7861/clinmed.Let.20.6.3. Clin Med (Lond). 2020. PMID: 33199342 Free PMC article. No abstract available.

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